Provider Demographics
NPI:1073069050
Name:ALLCARE HOMECARE AGENCY INC.
Entity Type:Organization
Organization Name:ALLCARE HOMECARE AGENCY INC.
Other - Org Name:VIVID CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TELNOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-492-3821
Mailing Address - Street 1:1502 KINGS HIGHWAY
Mailing Address - Street 2:3RD FL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229
Mailing Address - Country:US
Mailing Address - Phone:347-492-3821
Mailing Address - Fax:347-492-3822
Practice Address - Street 1:1502 KINGS HIGHWAY
Practice Address - Street 2:3RD FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:347-492-3821
Practice Address - Fax:347-492-3822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1940L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health